After about a year and a half of working in health care, and at least some casual reading of the relevant literature, I’m increasingly skeptical that a libertarian free market can provide an adequate basis for the provision of health care. The longer I work in the field, the more convinced I become of the essential truth of Kenneth Arrow’s famous insight about the economics of health care:
[T]he special economic problems of medical care can be explained by adaptations to uncertainty in the incidence of disease and in the efficacy of treatment (emphasis added).*
I’ve defended both the idea of cancellation in the abstract, as well as specific cancellations, done in specific ways, on this blog. My critics have done an end-run around what I’ve actually said about cancellation, as well as the examples I’ve adduced, focusing on the unintended consequences of cancellation that lead, or supposedly lead, to “lynch mobs,” the “thought police,” and the like.*
I still have a great deal more to say about cancellation as both a philosophical and a historical matter, but in honor of one of the greatest cancelers in American history, Martin Luther King Jr (whose birthday is celebrated tomorrow), I’ve decided to descend to casuistry and inaugurate Cancel Week: a week of posts devoted to nothing but cancellations and anti-cancellations. (Sotto voce confession: I have a lot more than seven examples at my disposal, so this “week” may last awhile. But if revolutionism entails revisionism, revisionism about the meaning of “week” is to be expected.)
I don’t remember the last time, if ever, that I ran three memorial posts in such close succession, but I wanted to mark the passing of my friend Carol Welsh (b. 1970) on the morning of Wednesday, December 29, 2021. Carol died of complications sustained over a 21-year struggle with a brain tumor, a recurrent ependymoma malignant by location. Continue reading
I heard today from a physician whose hospital is on the verge of collapse, and an ICU nurse at a different hospital who is likely struggling with COVID, but being instructed not to get tested so as not to miss work. Two fairly typical stories from the edge of the healthcare abyss, but entirely predictable and a long time in the making. “Hospitals are understaffed” is now common knowledge, not a news story. The question is why. There’s no way to answer that question in the absence of information about staffing and budget decisions, themselves connected to facts about medical billing and collecting. This article is a case in point.
I hate to run two memorial/obituary posts in a row, but this post by Chris Sciabarra, memorializing the generally unknown Hiromi Shinya, deserves a wider audience. I won’t try to summarize; just read it.
Getting a booster is no panacea, but not getting one may be a fatal mistake. That, at any rate, is the finding of a set of Israeli studies in the New England Journal of Medicine, one published in October, the other published just a few days ago. An excerpt from the abstract of the “Conclusions” section of the latter:
Across the age groups studied, rates of confirmed Covid-19 and severe illness were substantially lower among participants who received a booster dose of the BNT162b2 vaccine than among those who did not.
Read both articles all the way through for all of the relevant provisos and qualifications, but I think it’s fair to summarize both by saying that they jointly found that boosters reduced the incidence of both serious morbidity and mortality due to COVID-19, inclusive of all variants but Omicron (about which it’s too early to tell). Continue reading
This article just below reads like a companion piece to my earlier post on my late wife’s Alison’s struggles with chronic pain.
I agree almost entirely with Alana Saltz, the author of the article, and am saddened that Alison isn’t here to read it (in fact, I had to fight my initial impulse to send it to her). Saltz lays out many of the criticisms of CBT that Alison had made to me over the years, both as a therapist herself, and as someone with chronic pain. Before hearing those criticisms, I’d always had some vague unease about CBT that I wasn’t quite able to pinpoint. It wasn’t until Alison started expressing her criticisms of CBT in the direct, concrete, and vehement way characteristic of her that I was able to re-focus my own vague, nebbish doubts about it. I wrote some of those criticisms up for grad seminars in CBT back when I was a grad student in counseling, but never did anything with what I wrote. Saltz’s piece reinforces my confidence in my criticisms; maybe I ought to take the time to write them up. Here, in any case, is a quick summary.
My wife Alison was one of the casualties of the tragedy described in the article just below. She took her life this past March by overdosing (I surmise) on the medications she’d been prescribed for chronic pain. She explicitly told me over the years that she kept a stash with her at all times in case things got bad enough for her to have to take her own life. “I have no intention of living past 70,” she’d often say. She was 57.
In a previous post, I criticized George Sher’s view that merit-based desert is based on (the recognition of) existing conventions of merit. In these cases, the existing rules are already fashioned to reward merit in a justified way, so that justice (in the sense of rewarding desert) consists simply in acknowledging that a given person satisfies the criteria of merit, and acknowledging that in accepting the convention, we accept the further implication that the person deserves what the rules say they deserve. Continue reading
The value or worth of a man is, as of all other things, his price; that is to say, so much as would be given for the use of his power, and therefore is not absolute, but a thing dependent on the need and judgement of another.
–Hobbes, Leviathan, I.10.16
Sher’s account of desert and merit raises many questions, so let me double back to consider some of these, some addressed in his chapter, some not. I’d originally thought I’d leave the criticisms of Sher’s chapter at a single post, but it turns out that my criticisms have eaten up more space than I’ve thought they would. So this series on “Desert and Merit” is going to be longer than the promised or predicted two installments. Frankly, at this point, I couldn’t tell you how long it will be. As Michelangelo said (or is reported to me by Roderick Long to have said) about the Sistine Chapel, “It will be done when it is done.” I follow Michelangelo in such matters. Continue reading